Warfarin-Induced Skin Necrosis (WISN) is severe complication of oral anticoagulant therapy. Incidence is 0.01 to 0.1 percent of Warfarin-treated patients. Other cause hereditarydeficiency of protein C. patients with rapid loading of Warfarin and thrombophilic diseases is at high risk. Early recognition and prompt intervention of the condition is very important as anticoagulation is being used for major illness. Various theories of pathogenesis have been described. Skin necrosis represents as acomplicated and recalcitrant to conservative treatment. Since patient is not hemodynamically stable major surgery also cannot be done. Hence the condition remains a major diagnostic and therapeutic challenge for surgeon. We present a severe case of WISN of bilateral thigh which was managed with a minimal invasive bed side under local anesthesia by External Tissue Expansion Wound Contraction (ETEWC) and wound healed completely in short period of time.